Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses Health Study

Parker, William H. MD; Broder, Michael S. MD, MPH; Chang, Eunice PhD; Feskanich, Diane ScD; Farquhar, Cindy MD; Liu, Zhimae PhD; Shoupe, Donna MD; Berek, Jonathan S. MD, MMS; Hankinson, Susan ScD; Manson, JoAnn E. MD, DrPH

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181a11c64
Original Research
Journal Club
Abstract

OBJECTIVE: To report long-term health outcomes and mortality after oophorectomy or ovarian conservation.

METHODS: We conducted a prospective, observational study of 29,380 women participants of the Nurses’ Health Study who had a hysterectomy for benign disease; 16,345 (55.6%) had hysterectomy with bilateral oophorectomy, and 13,035 (44.4%) had hysterectomy with ovarian conservation. We evaluated incident events or death due to coronary heart disease (CHD), stroke, breast cancer, ovarian cancer, lung cancer, colorectal cancer, total cancers, hip fracture, pulmonary embolus, and death from all causes.

RESULTS: Over 24 years of follow-up, for women with hysterectomy and bilateral oophorectomy compared with ovarian conservation, the multivariable hazard ratios (HRs) were 1.12 (95% confidence interval [CI] 1.03–1.21) for total mortality, 1.17 (95% CI 1.02–1.35) for fatal plus nonfatal CHD, and 1.14 (95% CI 0.98–1.33) for stroke. Although the risks of breast (HR 0.75, 95% CI 0.68–0.84), ovarian (HR 0.04, 95% CI 0.01–0.09, number needed to treat=220), and total cancers (HR 0.90, 95% CI 0.84–0.96) decreased after oophorectomy, lung cancer incidence (HR=1.26, 95% CI 1.02–1.56, number needed to harm=190), and total cancer mortality (HR=1.17, 95% CI 1.04–1.32) increased. For those never having used estrogen therapy, bilateral oophorectomy before age 50 years was associated with an increased risk of all-cause mortality, CHD, and stroke. With an approximate 35-year life span after surgery, one additional death would be expected for every nine oophorectomies performed.

CONCLUSION: Compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease is associated with a decreased risk of breast and ovarian cancer but an increased risk of all-cause mortality, fatal and nonfatal coronary heart disease, and lung cancer. In no analysis or age group was oophorectomy associated with increased survival.

LEVEL OF EVIDENCE: II

In Brief

Oophorectomy is associated with an increased risk of all-cause mortality, fatal and nonfatal coronary heart disease, and lung cancer.

Author Information

From the 1John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, California; 2UCLA School of Medicine, Los Angeles, California; 3Partnership for Health Analytic Research, Los Angeles, California; 4Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; 5School of Medicine, University of Auckland, Auckland, New Zealand; 6Cerner Health Insights, Beverly Hills, California; 7Keck School of Medicine, University of Southern California, Los Angeles, California; 8Stanford University School of Medicine, Stanford, California; 9Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; and 10Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts.

Funded by grants from Ethicon Women’s Health and Partnership for Health Analytic Research.

The authors thank the women in The Nurses’ Health Study for their continuing contributions to the understanding of long-term health outcomes, and Dr. Shelley Tworoger and Dr. Bernard Rosner for providing their advice on the study design and statistical analyses without compensation.

Corresponding author: Dr. William H. Parker, Department of Obstetrics and Gynecology, John Wayne Cancer Institute at Saint John’s Health Center, 1450 10th Street, Santa Monica, CA 90401; e-mail: wparker@ucla.edu.

Financial Disclosure Dr. Parker has been a consultant to Ethicon Women’s Health (Cincinnati, OH). Dr. Broder is president of Partnership for Health Analytic Research (Los Angeles, CA). Dr. Chang is an employee of Partnership for Health Analytic Research. Dr. Farquhar has received consulting fees from the World Health Organization (Geneva, Switzerland). Dr. Shoupe has received a research grant from the NIH National Center of Complementary and Alternative Medicine (Gaithersburg, MD). Drs. Liu, Manson, Feskanich, Berek, and Manson did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.